If you are providing counseling on smoking and tobacco-use cessation during patient office visits, follow these guidelines to make sure you get paid accurately for it.
Not all medical policies are the same, so it is important to verify coverage prior to submitting the claim. Even though many payors follow Medicare, keep in mind not all do. Be sure to check with your local Medicare and commercial insurance for specific requirements.
Review the CPT codes and take note of the code description. The codes for these services are time-based. Therefore, you must document the time in minutes spent on counseling the patient on smoking and tobacco use cessation.
99406 – Smoking and tobacco use cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes
99407 – intensive, greater than 10 minutes
Diagnosis codes that will meet medical necessity will vary by payor. Always check the patient’s insurance policy. Below are just a few examples of codes found in most policies:
F17.200 – Nicotine dependence, unspecified, uncomplicated (includes mild, moderate, severe tobacco use disorder)
F17.201 – Nicotine dependence, unspecified, in remission
F17.210 – Nicotine dependence, cigarettes, uncomplicated
F17.211 – Nicotine dependence, cigarettes, in remission
F17.220 – Nicotine dependence, chewing tobacco, uncomplicated
F17.221 – Nicotine dependence, chewing tobacco, in remission
F17.290 – Nicotine dependence, other tobacco product, uncomplicated
F17.291 – Nicotine dependence, other tobacco product, in remission
T65.214A – Toxic effect of chewing tobacco, undetermined
T65.224A – Toxic effect of tobacco cigarettes, undetermined
The documentation in the medical record must support the codes assigned. Specifically, document what was discussed:
“I counseled the patient to quit smoking, but the patient responded he wasn’t ready to quit at this time.”
“The patient has atherosclerosis with an ulcer on the left toe but continues to smoke one pack of cigarettes per day. I spent 12 minutes counseling the patient on cessation techniques. She understands continuing to smoke could lead to unhealed ulcers, amputations and even death. The benefits of quitting were provided, and she agreed to give it a try. A goal was set to be smoke-free within the next six weeks. I will follow up in two weeks to check progress.”
Medicare and most commercial payors will allow payment for a medically necessary E/M service on the same day as smoking and tobacco counseling. Both services can be documented on the same report, but it is imperative to separate the time spent in minutes for each service. When both are done on the same day, assign modifier 25 to the E/M service code to indicate it was a separately identifiable.
Total time spent on an established patient office visit was 20 minutes. Separately, 5 minutes was spent counseling on smoking cessation.
99213-25 – Office visit
99406 – Smoking cessation
Medicare and certain payors will cover two attempts per year. Each attempt includes no more than four intermediate or intensive counseling sessions.
2022 Medicare Physician Fee Schedule National Payment Amount
CPT Code Non-Facility Facility
99406 $15.57 $12.11
99407 $28.72 $25.61
Copayment/coinsurance as well as the deductible for 99406 and 99407 are now waived. The Medicare beneficiary has a zero-dollar out-of-pocket liability.
CPT 2022 Professional Edition
2022 Medicare Physician Fee Schedule
NGS Medicare Q. & A.